Forcing nurses to work as aides

chris_at_lucas_RN, RN · Dec 22, 2004

Your employer doesn't have near the liability issues that you have, if a patient should be injured (or even in obvious risk of injury, enough to be afraid) on your "watch."

Part of being a nurse is knowing when to ask for help. A jury would certainly see it that way.

Another part is knowing at the very least the tasks and skills of persons subordinate to you. If you do not know how to do the tasks an aide can do, you maybe need to ask someone for some training, or get a good book on basic nursing skills, or google it or something. You should be able to do, with ease, the tasks of an aide.

Meantime, if you don't want to "work as an aide," then make sure that every opportunity you have to ask for help, you do. The other nurses will be a little annoyed, but eventually the charge nurse will give the aide job to somebody else.

Frankly, it sounds like they need more aides at your place, and if nurses are overscheduled, then somebody needs to get a day off.

The last two paragraphs are JMHO. I'm pretty sure the rest of it is fact. Check your state's nurse practice act or consult with someone on your board.

Good luck.

nursemaa · Dec 22, 2004

You really can't have nurses "working as aides"....the bottom line is that you will always be held to the standard of a nurse in court, regardless of the tasks you are performing at the time. And since bathing, vitals, moving patients, etc is part of basic nursing care, I don't see how you could use the argument that you weren't "trained" as an aide. As far as equipment goes, all staff should be trained regarding equipment used for patient care. The nurses should request this if it's not provided to them.

Why not suggest that when you don't have an aide and have too many nurses, you divide the patients up evenly and do primary care (helping each other with two-person tasks of course)?

findingmywayRN · Dec 22, 2004

Thanks for your responses. I sense that the impression of my post was that I do not want to "work as an aide." This is not the case. My concern is that I have not been trained on the equiptment they use on a regular basis, which I am expected to just learn as I go, combined with the physical demands of the job and my limitations. I have told my boss this and she said the nurses should all be trained on this equiptment, but there has not been any training provided so far. Just to make myself clear, I do know basic nursing care, how how to wash residents, take vitals, etc. I do not, however, know how to use a shower chair, or how to transfer a resident into or out of the tub/shower, using lifts, etc. and this worries me about liability as pointed out by nursemaa.

chris_at_lucas_RN I agree it is important to always ask for help, which I always do.

Hardknox · Dec 22, 2004

Thanks for your responses. I sense that the impression of my post was that I do not want to "work as an aide." This is not the case. My concern is that I have not been trained on the equiptment they use on a regular basis, which I am expected to just learn as I go, combined with the physical demands of the job and my limitations. I have told my boss this and she said the nurses should all be trained on this equiptment, but there has not been any training provided so far. Just to make myself clear, I do know basic nursing care, how how to wash residents, take vitals, etc. I do not, however, know how to use a shower chair, or how to transfer a resident into or out of the tub/shower, using lifts, etc. and this worries me about liability as pointed out by nursemaa.
chris_at_lucas_RN I agree it is important to always ask for help, which I always do.

When we had clinical we all had pts. that needed transfers, showers, hoyer lifting etc. Did you not learn any of this back then? Does your floor not have inservices to show you how to use new equipment? As a nurse I have had to perform these duties myself many times. Our aide couldn't do everything,

That being said, if the hospital is using you as an aide, as mine does when they float us off unit, if anything happens on your shift to your pt. the BON and therefore a jury, will hold you accountable as an RN. So you do need to get this matter straigtened out with your employer. It is your liscense and your livelihood.

bellcollector · Dec 22, 2004

Findingmyway, When I first began as a nurse I was frequently called in to work as an aid. The extra money was nice but what ended up being expected of me was not so nice. I have since grown and learned a lot. When I did this I would be doing the work of the aid but the nurses would hand me tx supplies and things and say hey since your in there anyway. Basically I ended up doing the job of two the aid and the nurse.

Yes I know the basics of nursing. I can give one heck of a bed bath, awesome oral care, shower residents, do simple and common transfers. Thing is when it comes to lifts and such they are all different and inservices on them and how they are operated are few and far between. If the STNA messes up and drops a resident causing harm they may be disciplined or even fired if found careless or neglectful. However if you drop a resident you could lose your license. While at work no matter what task you are doing you are held to the legal standard/accountability of a nurse.

It didn't take me to long to figure out it wasnt the same as doing primary care (which I have done)it is a whole different ball game. I do not recommend that a nurse work as an aid. JMO

mattsmom81 · Dec 22, 2004

You might present your case as a reasonable accomodation during pregnancy...I'm not sure it would fly but might be worth a try.

If my employer told me it was a requirement to work as an aide I would have to seek other employment, all things considered including physical AND liability issues.

Chris's statement is likely what you will hear from your manager if this is how she has decided to staff the facility.

Good luck to you and by all means do whats best for YOU and your little one. You always have choices.

nursbee04 · Dec 22, 2004

So the nurses are not responsible for knowing transfer techniques or how to use the lifts or other assistive equipment in the facility? I guess because you work LTC and have so many pt's you don't do much pt care, but still! I think you should ask for an inservice on these devices and I think if they want you to come in extra for patient care you should be at least oriented to the equipment and routine. You are the only one looking out for your license. No one but you will protect it, and it sounds like a big time risk in this situation. If a pt fell out of a lift you were operating and hadn't used before/been oriented to then you would be in it up to your eyeballs. We have a unit safety checklist for all new hires, and if it is equipment in use on our floor we are responsible for knowing how to use it. This includes anything from the blood warmer to the sari lift.

Can you get your doc to put you on restrictions due to your pregnancy?

MikeyBSN · Dec 22, 2004

During school we all learn how to give bed baths and move patients. I spent part of my first semester in a nursing home giving basic care. Nurse's aides are exactly that, a person who assists the nurse. It is not a separate job in the sense that they receive better training. You are the nurse; you are giving part of your duties as a nurse to assistive personel. It's your responsibility to know how to do everything the aide does. Technically, you delegate your nursing responsibility of bathing, moving ect. to that aide. You should not be delegating a task you don't know how to perform. If you're concerned about moving patients, ask another aide for help. I'll have a BSN when I'm finished and I'm sure there are times when I'll still have to wash patients and move them. Unless you work for an insurance company or something it's part of our job. I would go back to your foundations book and brush up on some basic nursing care so you know what you're doing and don't endanger your license. Or I'd quit my job and go work for a lawyer or something.

sheliamd · Dec 22, 2004

Not trying to be mean, but I agree with the others...how can you have completed a nursing program without learning the basics of nursing care? Just curious.... :confused:

Mystery5 · Dec 22, 2004

I would view it as a great opportunity to become really good at this stuff! You'll get paid as a nurse and become well versed in all these things that the aides do.

I know I feel a little intimidated at times because these aides are better at these types of tasks. It can put me at a disadvantage, since I'm supposed to be the one in charge. So, I try an always be open to learning from aides because some of them are really good. So, this is a great opportunity!:)

UM Review RN, ASN, RN · Dec 22, 2004

Wow, guys take it easy! Didn't any of you go through the Dreaded Newbies?

That's all you're seeing here. Give her a few inservices and a couple of weeks, and she'll be just fine.

Just to make myself clear, I do know basic nursing care, how how to wash residents, take vitals, etc. I do not, however, know how to use a shower chair, or how to transfer a resident into or out of the tub/shower, using lifts, etc.

First of all, you need to relax. Second, know that if you have to transfer a patient using a lift, you will need two people. It's not just the equipment you need to learn; it's the resident. While there are basic things that you learn for all residents, such as lifting techniques and operation of the mechanical devices, each resident has their own ROM and style to which you must adapt. This is why it's good to seek the advice of an aide who knows the resident's gait and lifting style. A demonstration wouldn't hurt either.

While you will be held to the standards of a nurse working as an aide, you would be responsible for the unlicensed staff working under your direction anyway.

So this will help you get to know the residents better and certainly give you more knowledge about their skin condition and bladder habits, something you miss a lot when you're busy passing meds all day.

I've worked as an aide when we were short or when I was precepting a new nurse, and all I could think was that I was getting paid pretty good for it.

So I say, cheer up! You can do this!